Fitri knows all too well what an acute shortage of blood in hospitals can mean. The woman from Merauke district in Papua found herself in severe pain in 2009 after contracting endometriosis, the development of uterine-lining tissue outside the uterus. The condition also brought on heavy periods, which meant part of the treatment required that she receive blood transfusions. However on being taken to hospital she was told there was very little blood available to treat her. "My husband had to go around asking friends to donate blood for me," said Fitri, who like many Indonesians goes by only one name. "Luckily, I was able to wait until my husband's friends came and donated their blood even though I should had been treated immediately," she said.

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Years later, the province continues to suffer from acute blood shortages, according to the Indonesian Red Cross. The humanitarian organization cited an example in 2013, when 66,000 blood bags were needed in the province but only around 2,700 were available. At national level, the World Health Organization (WHO) says the minimum blood demand in Indonesia, which has an estimated population of about 250 million people is 5.1 million blood bags per year, or two percent of its total population. However, the Health Ministry says it can only manage to gather on average 4.1 million blood bags per year and around 90 percent of this figure comes from the public donating at local blood centers. The rest comes from the Indonesian Red Cross or, like in Fitri's case, from family and friends of those who really need it. Key factors According to Putri Srihartaty, who heads the Indonesian Red Cross Society's Central Blood Transfusion Service, the key factor for the shortage is the small number of blood donations particularly during the Muslim holy month of Ramadan and long holidays. Many Muslims refrain from making blood donations during the holy month as they consider it as breaking the fast. Nearly 90 percent of the country's population is Muslim. The rest are Protestants, Catholics, Hindus, Buddhists and Confucians as well as followers of traditional beliefs. "This is why blood supply is insufficient," she said. There are also months when the Red Cross lacks certain blood types. "All 216 blood transfusion services across the country take all blood types from blood donors. But in certain months, there is no match between supply and demand," she said. For Sister Julia Sinaga, who manages the blood bank at Saint Elizabeth Hospital in Medan, North Sumatra, the situation is worrying. "We had no blood supplies for almost two days during Ramadan this year. As a result, patients had to wait until we could get blood bags from the local Red Cross or nearby hospitals," she said, adding that several patients with kidney failure had to undergo dialysis. In fact, the hospital provides more than 400 blood bags for patients every month. Saint Carolus Hospital in Central Jakarta chooses to get blood donations from patients' family members if shortages arise. According to hospital spokeswoman, Roestri Nurwulan, "Apart from Ramadan a fear of needles is also a major reason why people refuse to donate blood." Quick Wins program In July, Health Minister Nila F. Moeloek lamented people's ignorance on the importance of blood donations particularly in saving the lives of mothers going through a complicated childbirth. Around 28 percent of all maternal deaths last year were because of excess bleeding. And like everywhere else the country needs blood for a wide variety of medical procedures. To address the shortage problem, the ministry has reintroduced a program, first initiated in 2015, to increase the number of blood donors. In the Quick Wins program, the ministry will embrace 5,600 community healthcare centers by the end of 2019. Of this number, 2,394 centers have signed a memorandum of understanding with blood transfusion services and hospitals. The program aims at boosting blood supplies through cooperation between community healthcare centers, blood transfusion services and hospitals. Community healthcare centers are looking to mount awareness campaigns about shortages and encourage them to become blood donors. Prasetyo Nurhardjanto, who has regularly donated blood since 1989, believed that the Indonesian Red Cross can be more creative in dealing with such shortage. "Social media can be used to attract more people. Many communities of blood donor use the internet," he said.